Sharp drop in opioid prescriptions raises questions over different medication – Business Insurance

Opioid prescribing in staff compensation nosedived to an all-time low final 12 months, a brand new report finds, however specialists say there are issues with different medication getting used for ache administration. 

AmTrust Financial Services Inc. reported in October that solely 15.2% of its staff compensation claims for 2021 concerned an opioid prescription, down from 60% in 2017 and 25% in 2018. The information represents a discount of 75% in prescriptions containing an opioid over 4 years, the insurer mentioned. 

The numbers are according to different reviews. 

Enlyte Group LLC subsidiary Mitchell International Inc. reported in July that in 2021 30.3% of injured staff had opioid prescriptions.

Workers comp opioid spending has declined greater than 62% since 2016, in response to information collected in 2021 by Maggie Valley, North Carolina-based consulting firm CompPharma LLC. 

Concerns are rising, nonetheless, that different medication are transferring in to switch opioids as a ache administration go-to in comp. Foremost are nonsteroidal anti-inflammatory medication; neurological medication, akin to gabapentin, which goal nerve ache; topical lotions; muscle relaxers; and anti-anxiety medication in a category referred to as benzodiazepines, in response to specialists. 

The latter two are of specific concern, as they’re thought of sedatives just like opioids, although not as doubtlessly lethal, specialists say.

“While opioids have decreased significantly, it’s kind of become a more diffused problem, and it’s now branched out into other controlled substances,” mentioned Silvia Sacalis, a Tampa, Florida-based licensed pharmacist and vp of scientific companies for Healthesystems LLC. “These are other controlled substances that unfortunately have similar side effect profiles to opioids with the sedation and the impact on cognition, which is what keeps injured workers from returning to work.”

Just as there are pointers for opioids, pointers exist for medication akin to benzodiazepines and muscle relaxers, which restrict such medication to short-term use, mentioned Nikki Wilson, Omaha, Nebraska-based senior director of scientific companies for Mitchell Pharmacy Solutions, an Enlyte firm. 

“There are a lot of caveats for use, as both of them can be associated with dizziness and increased levels of nervous system depression,” she mentioned. “And official disability guidelines support use of muscle relaxants only for specific conditions, and not beyond 21 days of use. It’s acute only. So, this is one of the things we monitor even more for limited use.” 

Benzodiazepines are “one drug class that is important to talk about,” mentioned Dr. Marcos Iglesias, Hartford, Connecticut-based vp and chief medical director of Travelers Cos. Inc. “That’s because benzodiazepines have been used a lot in the industry with pain management.” The business, simply because it has with opioids, has been attempting to cut back benzodiazepine prescriptions, he mentioned, including that the figures are dropping. Muscle relaxers, nonetheless, are “flat” by way of prescriptions, he mentioned. 

“Every drug has some benefits and many of these drugs have risks, and some of them can be potentially quite severe,” Mr. Iglesias mentioned. 

It’s one motive managed care in comp is transferring away from medication — when potential, mentioned Melissa Burke, Southington, Connecticut-

based mostly vp and head of managed care and scientific for AmTrust Financial Services Inc.

“There are many other ways to treat pain than with opioids, and that’s where the industry has gone,” she mentioned. “We’re very vigilant about making certain (staff) have what they want. 

“If it’s post op, if they have an immediate need for a pain medication, they’re getting it; we are certainly not getting in the way of that. But we’re ensuring that step two and phase two of their injury recovery process is finding something that’s addressing their needs for pain management and addressing what’s causing the pain.” 

Sometimes, the reply is medication apart from opioids, she mentioned. This entails “identifying whether it is truly an anti-inflammatory need, or do we need something for neuropathy? Do we need a non-pharmacologic treatment like acupuncture therapy? Do they just need cognitive behavior therapy to address what’s internally driving them to focus on their pain?” she mentioned.

Doctors are additionally getting higher at options and continuing with warning, mentioned Dr. Adam Seidner, Hartford, Connecticut-based chief medical officer for Hartford Financial Services Group Inc.

“The doctors are making sure that they’re doing a proper assessment and that they have the proper management and that they feel comfortable taking care of these patients, both in the acute and chronic pain situations,” he mentioned. “The proper management of acute pain is … important because if it’s not done correctly, it can lead to long-term, chronic pain.” 

And whereas opioids have gone down “drastically” in comp, it doesn’t imply the business’s work is completed, mentioned Joe Paduda, Skaneateles, New York-based president of CompPharma LLC. 

“While the actual prescription reporting for workers compensation claimants, for drugs paid for by workers comp, has gone down, it does not mean that all those patients who were taking opioids that were paid for by workers comp are not still taking opioids.” 

There are causes to suspect injured staff are tapping into group well being insurance policies, or paying money for opioids, and nonetheless going to work, he mentioned. 

Ms. Sacalis, who has spoken out towards points with “polypharmacy” amongst injured staff who could also be on different medicines unrelated to their work damage, warns “it’s now important to be more vigilant than ever” in managing prescriptions.






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